Total Hip Arthroplasty in Patients With Sickle Cell Disease: A Comprehensive Systematic Review

• Published in: The Journal of arthroplasty Vol. 35; no. 8; pp. 2286 - 2295
• Main Authors: Fassihi, Safa C., Lee, Ryan, Quan, Theodore, Tran, Andrew A., Stake, Seth N., Unger, Anthony S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2020
• Subjects: Anemia, Sickle Cell - complications; Anemia, Sickle Cell - surgery; Arthroplasty, Replacement, Hip - adverse effects; Humans; Osteoarthritis; osteonecrosis; Osteonecrosis - epidemiology; Osteonecrosis - etiology; Osteonecrosis - surgery; postoperative complications; Reoperation; revision; sickle cell disease; total hip arthroplasty; total hip replacement; Treatment Outcome; total hip replacement; postoperative complications; total hip arthroplasty; osteonecrosis; sickle cell disease; revision
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2020.04.014

Total hip arthroplasty (THA) is a common treatment for end-stage osteonecrosis of the hip in patients with sickle cell disease (SCD). This patient population presents unique challenges in the perioperative period. This systematic review aims to investigate the existing literature on the outcomes, complications, and survivorship of primary THA in SCD patients. A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed of PubMed, MEDLINE, EMBASE, and Cochrane databases for clinical studies on THA in SCD patients. Studies on primary THA in SCD patients with a mean follow-up greater than 90 days were included. Sixteen studies containing 5193 SCD patients met criteria for inclusion. The Coleman Quality of Evidence score ranged from poor to moderate. SCD patients had a significant increase in Harris Hip Scores and Merle d’Aubigne Scores after undergoing THA. Compared to non-SCD patients, SCD patients had increased hospital length-of-stay, 30-day and 90-day readmission rates, and rates of medical complications, including pain crises, acute chest syndrome, cardiac complications, sepsis, and mortality. SCD patients also had increased rates of surgical complications, including wound complications, infection, periprosthetic fracture, and aseptic loosening. Overall, THA revision rates were higher in SCD patients relative to those with primary osteoarthritis. THA remains an effective treatment modality for osteonecrosis of the hip in SCD patients. However, these patients are at increased risk of medical and surgical complications. Surgeons should be aware of the unique challenges in this patient population when counseling and managing these patients in the perioperative period.